指南与共识妇科

宫颈癌筛查:女性预防服务倡议推荐

Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative.
指南 / 共识 · Obstet Gynecol · 2026-04-23

美国女性预防服务倡议(WPSI)更新了平均风险女性宫颈癌筛查推荐,新增患者自采高危人乳头瘤病毒(hrHPV)筛查及后续随访检测。新证据显示原发hrHPV筛查较细胞学筛查提高癌前病变检出,患者自采与医生采样检测准确性相似。指南推荐21-65岁平均风险女性筛查,并按年龄分层确定方法及间隔。

要点

  • 21-29岁女性每3年一次宫颈细胞学筛查,不推荐30岁以下联合检测。
  • 30-65岁首选原发hrHPV检测或联合检测每5年一次,不能hrHPV检测时细胞学每3年。
  • 患者自采hrHPV是30-65岁平均风险女性的合适筛查方法,筛查不应超过每3年一次。

核心结论

  • WPSI推荐21-65岁平均风险女性进行宫颈癌筛查,并新增患者自采hrHPV作为30-65岁女性的筛查选择。

研究设计与样本

  • 该推荐由女性预防服务倡议(WPSI)基于新证据更新,针对平均风险女性。

主要发现

  • 新证据表明原发hrHPV筛查较细胞学筛查增加癌前病变检出,患者自采hrHPV检测准确性相似且可能减少筛查障碍。

关键数值与推荐

  • 21-29岁女性推荐每3年宫颈细胞学筛查,不推荐30岁以下联合检测。
  • 30-65岁女性推荐原发hrHPV检测(首选)或联合检测每5年一次;不能hrHPV检测时细胞学每3年可接受。
  • 平均风险女性筛查频率不应超过每3年一次。
  • 患者自采hrHPV是30-65岁平均风险女性的合适筛查方法。
  • 新推荐(含初始筛查阳性后的后续检测)已获美国HRSA批准,自2027年起对多数符合条件女性覆盖免共付和免自付额。

临床怎么用

  • 按年龄选择筛查方法:21-29岁细胞学每3年,30-65岁首选hrHPV每5年或联合检测每5年。
  • 可为30-65岁平均风险女性提供患者自采hrHPV筛查,并确保阳性结果后的后续检测。

以上解读依据论文摘要(全文未开放获取或许可不允许翻译转载)。

原文

The Women's Preventive Services Initiative (WPSI) expanded its previous cervical cancer screening recommendation for average-risk women by including patient-collected high-risk human papillomavirus (hrHPV) screening tests and additional follow-up testing needed to complete the screening process. To update the previous recommendation, the WPSI identified new evidence demonstrating that primary hrHPV screening increases detection of precancerous lesions compared with cytology screening. New studies indicate that patient-collected hrHPV testing has similar test accuracy for precancer detection compared with clinician-collected samples and may reduce barriers to screening. Consistent with the previous recommendation, the WPSI recommends cervical cancer screening for average-risk women aged 21-65 years. For women aged 21-29 years, screening using cervical cytology (Pap test) every 3 years is recommended; co-testing with cytology and hrHPV testing is not recommended for those younger than 30 years. For women aged 30-65 years, primary hrHPV testing (preferred method) or co-testing (cytology with hrHPV) every 5 years is recommended; if hrHPV testing cannot be performed, cytology every 3 years is acceptable. Women at average risk should not be screened more than once every 3 years. Patient-collected hrHPV is an appropriate screening method for average-risk women aged 30-65 years. The new recommendation-including additional testing to follow up on findings on the initial screening-was recently approved by the Health Resources & Services Administration, U.S. Department of Health and Human Services, for coverage without co-pay or deductible charges for most eligible women beginning in 2027.

来源:Obstet Gynecol,查看原文。版权归原作者所有。

引用

  1. Vosooney A, Witkop CT, Cantor AG, et al. Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative. Obstet Gynecol. 2026. PMID: 42024880. doi:10.1097/AOG.0000000000006315

供执业医师工作参考,不替代临床判断;数值与分级以指南原文为准。